1
|
Kurpad K, Mehta H, Sohal S, Garg N, Gopal S, Zainib M, Suthar K, Jumkhawala S, Ahsan M, Hawthorne K. In hospital outcomes of orbital/rotational coronary atherectomy in diabetic vs non-diabetic population: insights from the nationwide inpatient sample. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atherectomy (AT) using an orbital/rotational system is useful in altering calcified plaque thereby facilitating stent placement and optimal stent expansion. Patients with diabetes mellitus (DM) are known to have a higher rate of complications after percutaneous coronary intervention. We aimed to assess the incidence of major adverse cardiovascular events after atherectomy in the diabetic population using a nationwide inpatient sample (NIS).
Methods
NIS-HCUP database from 2015–2017 was used to identify patients who underwent atherectomy. A cohort of patients with and without diabetes was identified. Demographics, in-hospital outcomes, complications in both groups were compared. Statistical significance was assigned at p<0.05.
Results
Out of 6184 patients who underwent AT, 3134 (50.6%) patients had DM. Baseline characteristics have been outlined in the table below. Complications were comparable between the two groups except for higher incidence of post-procedure VTE in Diabetic patients. In-hospital mortality was lower among patients with DM (2.24% vs 3.29%, p-0.27), while the mean length of stay (5.92 vs 4.91 days, p-0.002) and the hospitalization charges ($165118.4 vs 151226, p-0.04) were higher, but this difference in length of stay and hospitalization charges were nullified on multivariate regression.
Conclusion
Our study suggests that an AT for severely calcified plaque in the coronary artery is a safe option in patients with DM with comparable in-hospital complications and outcomes to non-DM patients.
Funding Acknowledgement
Type of funding sources: None. Demographics and Outcomes of Atherectomy
Collapse
Affiliation(s)
- K Kurpad
- Saint Barnabas Medical Center, Livingston, United States of America
| | - H Mehta
- Saint Barnabas Medical Center, Livingston, United States of America
| | - S Sohal
- Newark Beth Israel Medical Center, Cardiology, Newark, United States of America
| | - N Garg
- Saint Barnabas Medical Center, Livingston, United States of America
| | - S Gopal
- Saint Barnabas Medical Center, Livingston, United States of America
| | - M Zainib
- Rutgers New Jersey Medical School, Internal Medicine, Newark, United States of America
| | - K Suthar
- Rutgers New Jersey Medical School, Internal Medicine, Newark, United States of America
| | - S Jumkhawala
- Rutgers New Jersey Medical School, Internal Medicine, Newark, United States of America
| | - M Ahsan
- Saint Barnabas Medical Center, Livingston, United States of America
| | - K Hawthorne
- Saint Barnabas Medical Center, Cardiology, Livingston, United States of America
| |
Collapse
|
2
|
Mehta H, Kurpad K, Okoh A, Singh S, Berman J, Hawthorne K. Outcomes of transcatheter mitral valve repair from the latest nationwide inpatient sample database 2016–2017. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Transcatheter mitral valve repair (TMVR) is an alternative treatment option for severe mitral regurgitation (severe MR) in patients with high surgical risk. Previous studies have demonstrated safety and efficacy of TMVR. The aim of our study was to assess comorbid and patient outcome data in a nationwide sample.
Methods
From the Nationwide Inpatient Sample (NIS) 2016–2017, all adult patients with mitral valve regurgitation were identified. Patients were divided into two group- TMVR and SMVR (surgical mitral valve repair). Patients requiring surgical valve replacement were excluded. Primary outcomes were inpatient mortality and length of stay. Multivariate analysis was performed to adjust for comorbidities.
Results
A total of 6211 TMVR were performed, while 3789 SMVR were performed. TMVR patients were older (78.34 vs 62.26 years) and had more females (48.86 vs 36.18%). Comorbidities were higher in the TMVR group [heart failure (81.02 vs 46.02%, p<0.001), diabetes mellitus (27.13 vs 15.81%, p<0.001), chronic kidney disease (39.3 vs 13.7%, p<0.001), chronic lung disease (27.13 vs 16.65%, p<0.001). Complications were higher in the SMVR [Cardiogenic shock (3.8 vs 6%, p=0.007), blood transfusion requirement (19.44 vs 4.85%, p=0.001), respiratory failure (10.99 vs 7.37, p=0.012)]. Mean length of stay was higher with SMVR [8.60±0.22 (4.139–5.17) days] compared to TMVR [4.65±0.26 (8.167–9.03) days]. In-patient mortality was lower in TMVR (2.01 vs 2.45%, p-0.02). After adjusting for comorbidities on multivariate analysis, there was no difference in mortality between the groups (adjusted OR=1.081±0.419 (0.506–2.311).
Conclusion
From nationwide data, we report TMVR as a relatively safe treatment modality for severe MR, with comparable inpatient mortality and fewer complications than SMVR, despite having a significantly higher burden of comorbidities.
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- H Mehta
- Saint Barnabas Medical Center, Internal Medicine, Livingston, United States of America
| | - K Kurpad
- Saint Barnabas Medical Center, Internal Medicine, Livingston, United States of America
| | - A Okoh
- Newark Beth Israel Medical Center, Newark, United States of America
| | - S Singh
- Newark Beth Israel Medical Center, Cardiology, Newark, United States of America
| | - J Berman
- Saint Barnabas Medical Center, Internal Medicine, Livingston, United States of America
| | - K Hawthorne
- Saint Barnabas Medical Center, Cardiology, Livingston, United States of America
| |
Collapse
|